Bone Regeneration: Current Status and Future Prospects

The ability of bone to heal with practically no scarring is the most extraordinary feature of it. However, perturbations of the fracture site could disrupt the repair process when defects reach a critical size, resulting in non‐union. Current therapies include allografting, autografting, applying vascularized grafts, and other bone transport techniques. However, although commonplace in orthopaedic surgery, these treatments have some limitations

In-hospital and late outcome of rescue versus primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

Introduction: Despite high technical success of rescue Percutaneous Coronary Intervention (PCI) and also its significant impact on left ventricular function, the therapeutic outcome of this PCI technique in comparison with primary PCI for coronary reperfusion has remained uncertain. The present study aimed to conduct a comparative analysis of early and long-term results of patients with ST-Elevation Myocardial Infarction (STEMI), who had undergone primary or rescue PCI.Methods: One hundred and twenty-nine consecutive patients with the diagnosis of STEMI, who underwent primary PCI (n = 107) or rescue PCI (n = 22) from April 2012 to September 2013 were retrospectively included. In addition to early assessment of procedural consequences, the patients were followed-up to assess and compare long-term mortality and major adverse cardiovascular events.Results: Comparing in-hospital consequences of the two rescue PCI and primary PCI procedures showed no significant differences in in-hospital mortality (9.5% vs. 3.7%, P = 0.255), total hospital stay (6.32 ± 2.24 days vs. 6.61 ± 3.43 days, P = 0.720) and also in early procedural complications. Long-term death was found only in 1.9% of patients in the primary group and none of the patients in the rescue group (P = 0.999). There was also no difference in the prevalence of late stent thrombosis between the two groups. However, the in-hospital Left Ventricular Ejection Fraction (LVEF) was lower in the rescue PCI group vs. primary PCI group (36.82 ± 11.19 vs. 43.48 ± 9.14, P = 0.014), but after six months, LVEF was similar between the two groups (41.05 ± 9.57 vs. 44.29 ± 10.35, P = 0.082).Conclusions: Our study showed no difference in early and late procedural outcome between the primary and rescue PCI techniques in STEMI patients, but LVEF had better improvement in the rescue PCI group

Damage Source Identification of Reinforced Concrete Structure Using Acoustic Emission Technique

Acoustic emission (AE) technique is one of the nondestructive evaluation (NDE) techniques that have been considered as the prime candidate for structural health and damagemonitoring in loaded structures. This technique was employed for investigation process of damage in reinforced concrete (RC) frame specimens. A number of reinforced concrete RC frames were tested under loading cycle and were simultaneously monitored using AE.The AE test data were analyzed using the AE source location analysis method. The results showed that AE technique is suitable to identify the sources location of damage in RC structures

The Effect of Hyperuricemia on the Rate of Contrast-Induced Nephropathy in Patients with Coronary Angiography

Introduction: There is little information about the relationship between hyperuricemia and contrast induced nephropathy. The present study aimed to evaluate the relationship between hyperuricemia and contrast induced nephropathy among patients, who had undergone coronary angiography.Methods: In the current study, 200 consecutive patients with coronary artery disease, who underwent coronary angiography in Modarres hospital, were enrolled. According to the available data, the upper limit normal level of uric acid was defined as 7 mg/dl in males and 6.5 mg/dl in females. By increasing level of serum creatinine to 0.5 mg/dl (or 25% enhancement) from basic level of creatinine during 48 hours of introduction of contrast agent, diagnosis of Contrast Induced Nephropathy (CIN) was established. The relationship between hyperuricemia and CIN was then assessed.Results: There is a significant difference between normouricemic patients and hyperuricemic patients, in aspect of weight (P = 0.011) and uric acid (P = 0.001); however, other quantitative and qualitative variables including age, volume of contract agent, creatinine level after angiography, hemoglobin level, gender, arterial access type, number of involved vessels, were insignificant between the two groups (P > 0.05). Moreover, as an essential finding, CIN was shown in 9% of normouricemic patients and 10% of hyperuricemic  patients with no significant difference between the two groups (P = 0.6).Conclusions: Our study suggests that hyperuricemia may not significantly increase the rate of the contrast-induced nephropathy in patients, who had undergone angiograph

One- and Six-month Outcomes of Patients with Non-ST Elevation Myocardial Infarction

Introduction: Use of risk scoring systems in patients with acute coronary syndrome helps with summarizing important prognostic data of the disease and facilitates calculating confidence limits and comparing survival rates between different treatments. In the present study, the researchers first aimed at assessing mid-term outcome of patients with non-ST elevation myocardial infarction (NSTEMI), and then determining main predictors of this outcome to improve definitive criteria for designing a risk scoring system in the population.Methods: In a prospective cohort study, 124 patients with NSTEMI, diagnosed according to ACC/AHA guidelines and hospitalized in an academic hospital in 2013, were consecutively assessed. Baseline characteristics were collected via interviewing, physical examination, and reviewing the recorded files. All the patients were followed for one and six months to assess mid-term outcomes regarding mortality and major adverse cardiac events (MACE). MACE is defined as the occurrence of at least one of the events of death, myocardial infarction, repeated revascularization, or re-hospitalization.Results: One-month death occurred in 3.2%, re-hospitalization in 4.0%, and myocardial infarction in none of the patients. In addition, regarding the six-month outcomes status, mortality rate was determined in 6.4%, re-hospitalization in 22.6%, and myocardial infarction in 4.8% of patients. Hence, one- and six-month MACE rates were 7.3% and 27.4%, respectively. Furthermore, three- and six-month survival rates were estimated to be 96.8% and 93.6%, respectively. According to the Cox-proportion hazard modeling, only reduced left ventricular ejection fraction (LVEF) (HR = 0.909, P = 0.017), history of chronic kidney injury (HR = 8.884, P = 0.005), and Inotrope use (HR = 35.759, P = 0.012) could predict the six-month MACE. None of the other indexes including general coronary risk factors, echocardiography parameters, and level of cardiac enzymes could predict mortality rate.Conclusions: Patients with NSTEMI may face high six-month MACE which can be predicted by low LVEF, history of renal injury and use of inotrope. Therefore, to define risk stratification system, these indicators should be considered as well

The Correlation between Serum Level of N-Terminal Pro-B-type Natriuretic Peptide and Gensini Score in Patients with Acute Coronary Syndrome

Introduction: N-terminal pro-B-type natriuretic peptide (NT-proBNP) has emerged as an important biomarker for developing the diagnosis and prognosis of cardiovascular diseases, as several studies have shown that serum levels of NT-proBNP elevate in acute coronary syndrome (ACS) and coronary artery disease (CAD). We performed this study to find any possible correlation between serum levels of NT-proBNP and Gensini score in patients diagnosed with ACS.Methods: In a cross-sectional study, 100 consecutive patients with ACS who were candidates of angiography were recruited and their serum levels of NT-proBNP, Gensini scores, lipid profiles and troponin I levels were measured.Results: Sixty six male and 34 female patients with a mean age of 57.5 years, including 44 with unstable angina, 33 with ST-elevation myocardial infarction, and 23 with non-ST-elevation myocardial infarction were enrolled. The mean serum NT-proBNP level and the Gensini score were 1987.16 pg/mL (17.9-8841) and 31.09 (6-92.5), respectively. The serum NT-proBNP levels and Gensini scores were significantly correlated with a Spearman correlation coefficient of 0.953 (P < 0.001). Serum levels of NT-proBNP were not different in patients with single-vessel disease, 2-vessel disease and 3-vessel disease (P = 0.257). NT-Pro-BNP levels were also correlated positively with troponin I levels (correlation coefficient = 0.779) and negatively with left ventricular ejection fraction (correlation coefficient = -0.55). Smoker patients had higher NT-proBNP levels (P = 0.047). Neither Gensini scores nor NT-Pro-BNP levels had significant correlation with lipid profile or blood sugar.Conclusions: NT-proBNP is directly correlated with Gensini score in patients with ACS and might be used as an important marker for risk stratification in those patients

Angiosarcoma of the Right Atrium with Extension to SVC and IVC Presenting with Complete Heart Block and Significant Pericardial Effusion

Primary cardiac neoplasms are particularly unusual. Angiosarcoma is the most frequently seen histological subtype and is described by its infiltrating and damaging nature. Inappropriately, primary cardiac angiosarcoma is often missed as a preliminary diagnosis because of its scarcity. We present a 29-year-old previously healthy man with complete heart block and pericardial effusion who was finally diagnosed with angiosarcoma of the right atrium with extension to SVC and IVC

Exploitation of resources and cardiovascular outcomes in low-risk patients with chest pain hospitalized in coronary care units

Habibollah Saadat¹, Hossein Shiri², Zahra Salarpour², Tahereh Ashktorab² , Hamid Alavi Majd², Zahra Saadat¹, Hosein Vakili¹ 1Cardiovascular Research Center, Modarres Hospital, Shaheed Beheshti University of Medical Sciences, Tehran; 2Nursing School, Shaheed Beheshti University of Medical Sciences, Tehran, Iran Background: Most patients who present to medical centers due to chest pain do not suffer from acute coronary syndromes and do not need to be hospitalized in coronary care units (CCUs). This study was done to determine exploitation of resources and cardiovascular outcomes in low-risk patients with chest pain hospitalized in CCUs of educational hospitals affiliated with a major medical university. Methods: Over a 4-month period, 550 patients with chest pain who were hospitalized in the CCUs belonging to six hospitals affiliated to the authors' medical university were recruited by census method. Using Thrombolysis in Myocardial Infarction risk score, 95 patients (17.27%) were categorized as low-risk patients. This group was evaluated with respect to demographics, bed occupancy rate, mean hospitalization period, expenses during admission, and cardiovascular outcomes in the 30-day period postdischarge. Results: Mean (± standard deviation) hospitalization duration was 3.04 (±0.71) days. No significant difference was seen between the six surveyed hospitals regarding hospitalization duration (P = 0.602). The highest bed occupancy rate was seen in Taleghani and Shohada Tajrish hospitals and the lowest was in Modarres Hospital. The mean paid treatment expenses by low-risk patients was IRR 2,050,000 (US$205). Mean total hospitalization expenses was US$205. No significant difference was seen between the six surveyed hospitals (P = 0.699). Of the patients studied, 89.5% did not show any cardiovascular complications in 1 month and no deaths occurred. Conclusion: Given the high bed-occupancy rate by low-risk patients, associated high hospitalization costs, and the lack of cardiovascular complications in patients observed at 1-month follow-up after discharge, it is recommended that appropriate evaluations be performed in emergency units to prevent unnecessary admissions. Keywords: bed occupancy, hospitalization expenses, low-risk patients, chest pain, exploitation of resource

A competency Model of the Organization's Strategy Consultant

Today, the use of strategy consultancy in most organizations is not a choice, but a necessity. Strategy consultants have irreplaceable role in the success of organizations. Competency and competency-based management has been considered widely in recent years. Despite this fact, less attention has been paid to competencies of strategy consultants. This study aims to discover the competencies, determine the relative importance of each competency and finally suggest a comprehensive competency model for strategy consultants. So a mixed (qualitative-quantitative) research was conducted. At the first stage (qualitative research) based on the data approach of Glaser grounded theory and through deep interviews with 21 experts in strategy consulting, 25 competencies of strategy consultants were identified. At the second stage (quantitative research), by fuzzy Dematel method, relative importance of these competencies and the relationships between them have been identified and finally a comprehensive model has been presented. Among the important results of this research is that at the level of main categories, personality competencies and at the level of sub-categories, management and organizational knowledge, strategic thinking, mindfulness and leading the leaders are of the highest importance and effectiveness